Inspection on 27/04/09 for Wilton Lodge

This inspection was carried out on 27th April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wilton Lodge 22/05/08

Wilton Lodge 05/02/08

Wilton Lodge 23/08/07

Wilton Lodge 13/06/06

Wilton Lodge 31/10/05

Wilton Lodge 24/06/05

Wilton Lodge 21/12/04

Wilton Lodge 29/06/04

Wilton Lodge 29/01/03

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Key inspection report Care homes for older people Name: Address: Wilton Lodge 55 Wilton Road Bexhill-on-sea East Sussex TN40 1HX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Calveley     Date: 2 7 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Wilton Lodge 55 Wilton Road Bexhill-on-sea East Sussex TN40 1HX 01424216250 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: wilton@angelhealthcare.co.uk www.angelhealthcare.co.uk Angel Healthcare Ltd care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Wilton Lodge is a Victorian terraced property set close to the seafront and town centre in Bexhill-on-Sea. There are bus routes and a mainline railway station within a short distance. The home, one of four care homes owned by Angel Healthcare Limited is registered to provide residential and social care for twelve older people with dementia type illnesses. Accommodation is provided on three floors. Stair lifts are fitted, providing assisted access to rooms on the first and second floors. There is a staff sleep-in room on the fourth floor that doubles as the managers office. At the rear of the premises is a small, private courtyard for use by residents. The layout of the home is not suitable for service users who have a physical mobility restriction. Potential service users find out about the service via word of mouth, Angel Healthcare website, brochure, contacting the home direct, through care managers and Care Homes for Older People Page 4 of 31 12 Over 65 0 Brief description of the care home placing authorities. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Wilton Lodge will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with residents representatives and visiting health and social care professionals. This unannounced inspection was carried out over 5 hours on the 27 April 2009. There were ten residents living in the home on the day of which three were case tracked and spoken with. The purpose of the inspection was to ensure that the requirements set at the last key Care Homes for Older People Page 6 of 31 inspection had been met within the given timescales and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Three members of care staff were spoken with in addition to discussion with the Manager. Telephone contact was made with visiting professionals following the visit and one relative was spoken with also following the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received completed in full prior to this key inspection and received within the given timescale. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 31 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission and are assured in writing that their needs will be met. Evidence: There is a comprehensive Statement of Purpose and Service Users Guide which contain clear information about the home the range of fees charged and the services it provides. Copies of these have been sent to the all the residents and their families. It was discussed that the Statement of Purpose needs to be very clear about the mobility status of prospective residents due to the layout of the home. It was confirmed that the contract arrangements are clear and these will be updated to encompass fee increases and changes in the accommodation. There is a copy of the terms and conditions of residency included in the Service Users Guide. Care Homes for Older People Page 11 of 31 Evidence: Two of the most recent admissions to the home were reviewed and confirmed that the pre-admission assessments are completed by the registered provider. It was not however documented if a member of the home staff was also involved. To ensure that the prospective admission is appropriate a member of the homes care team should be involved in this important process. The format of the pre-admission document was seen to be thorough and relevant. The assessments contain all the information required to ensure that new admissions to the home are suitable and that the home have the staff and environment to meet the care needs of their needs. This is especially important for their mobility needs as the layout of the home is not suitable for residents who are restricted to wheelchairs at this time. It was confirmed that prospective residents are seen either in their home or hospital before admission and the manager confirmed that wherever possible the family or representatives are involved. It was evidenced that the home now confirms in writing that having regard to the assessment that the home can meet the assessed needs of the prospective resident. The manager was again able to verbally demonstrate his knowledge and awareness of the different specialities required in the home and ensures that the carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged, this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Intermediate or rehabilitative care is not provided at Wilton lodge Care Home. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plan documentation is now easier to follow and clearly identifies the needs of the residents with clear guidance for staff to follow. All care is delivered in a way that protects residents privacy and dignity and promotes their independence. Evidence: The care documentation pertaining to four residents were reviewed as part of the inspection process. The manager has plans to introduce their new care plan format in full with the next new admission. At present the manager has reviewed the care plans and removed the duplication of information and this has improved the documentation and enables staff to track the individuals care more easily. The care documentation was found to include plans of care specific to individual residents, nutritional assessments, personal histories and risk assessments. On the whole the care documentation demonstrated that the care was reviewed and evaluated on a regular basis. Areas that need to be developed were fully discussed and include: Social care plans, triggers and risk assessnts for aggression and wandering. The manager acknowledged these shortfalls and will address the shortfalls so a requirement was not Care Homes for Older People Page 13 of 31 Evidence: made at this time, this will be reviewed in depth at the next key inspection. Risk assessments for associated health needs are included in the care plans used by the home and have been developed since the last key inspection. However there are still areas that need to be addressed and these include: inappropriate behaviour management and moving people safely between the lounge and the dining area. This was also discussed in full with the manager. Residents are registered with a GP from the local surgery. Residents are supported to attend the GP surgery if appropriate and home visits are conducted when necessary. Referrals to the Optician, Dietician and Audiologist are made via the GP or the hospital. Residents access private dental surgeries where able and a domiciliary dentist will visit on request. A visiting Chiropodist attends residents six weekly with additional appointments being arranged if necessary. The records in the home evidence that the health needs of the residents are met. Staff spoken with confirmed that they received a report on each resident daily and read the daily care documentation that is kept in the dining room. They also felt that their views were taken into account when planning residents care. There is no designated clinical room and medications are stored in a lockable cupboard in the dining room. These cupboards are kept clean and well organised. The home has clear policies and procedures in place for staff to refer to regarding the safe administration storage disposal and recording of medication, the AQAA stated that they recently been updated. A monitored dose box system is in place for the majority of medications prescribed. The pharmacy has provided a special fridge bag for medications that are to be kept in the fridge. The risk factors in respect of medications being kept in the fridge were discussed and as residents do enter the kitchen at times this is an area tht would benefit from a regular review. There are systems in place for the recording and checking of controlled drugs when required, there are no controlled substances at present. Medication Administration Charts MAR were found to be competently completed. Staff signatures are now in place to identify staff and provide an audit trail. The areas of poor practice previously identified have been actioned and there were no recommendations of good practice made at this time. It was confirmed that all staff receive medication training to ensure that that they are competent. Regular assessment of competency and refresher training is included in the training matrix. The staff on duty were seen to be respectful and considerate to all residents whilst Care Homes for Older People Page 14 of 31 Evidence: attending to their needs and the interaction observed was open and friendly. There is a Privacy and Dignity policy in place and this is reviewed regularly. The protection of residents privacy and dignity is highlighted as one of the main aims of the home in its Statement of Purpose and Service User Guide. Each of the residents were addressed by their preferred term and dressed appropriately in welllaundered clothing Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides various activities on a daily basis which enables residents to enjoy a stimulating lifestyle Residents are supported and enabled to maintain contact with friends and relatives Meals remain good in respect of both quality and variety that meets the majority of residents tastes and choice Evidence: The activity programme for the week is displayed on the notice board and demonstrated a variety of daily activities which are popular with the residents and include singing and comedy sessions, reminiscence, aromatherapy, shopping trips, helping with household chores and cooking. Discussion with the registered manager confirmed that they are always thinking of new activities that the residents may enjoy. There is a social care plan, but not all were yet completely completed. Staff record the residents interaction daily and it was confirmed the records will be developed into a individual plan of activities. As this is a work in progress a requirement has not been made at this time. By direct observation it was observed that a designated member of staff takes the responsibility daily for activities and floor skittles was played in the afternoon of the site visit. Staff spoken with were enthusiastic about the sessions and discussed how the residents enjoy them. Care Homes for Older People Page 16 of 31 Evidence: Residents religious wishes are taken into consideration and arrangements are made for residents to receive Holy Communion if they choose to. Residents are supported and facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents. Residents families confirmed that they are welcomed at any time and made to be feel comfortable with their hospitality. Residents rooms were homely and comfortable with good quality furniture and families and residents are encouraged to personalise it with their own items. It was observed during the inspection that the routines at the home are flexible, residents were seen choosing where they sat and where they spent their time during the visit. The home has an advocacy policy in place and the information regarding this is available to all residents and their families. Residents were observed to be treated with respect and there was a good rapport observed between the staff of the home and residents. The dining room is situated at the rear of the house next to the kitchen. It has been redecorated since the last visit to the home and is furnished with good quality domestic furniture and a simple decor with plenty of natural light. One of the tables was unevenly balanced and this could be discerning for some resident, staff rectified this during lunch. It was identified at the last key inspection that the access to the dining room is not ideal for the residents that are reliant on a wheelchair due to the steps and narrow doorway and advice was to be sought. The manager said that it been discussed but no action taken. Residents positioning at the table needs to be continually assessed to ensure it is suitable for encouraging independence. Staff assisted residents with their meals in a dignified manner and all residents now have cloth napkins and bibs. The residents dependency levels need to be reviewed regularly against staffing levels to ensure that all residents that need assistance receive hot food. The menu evidenced a well-balanced nutritious diet which rotates 4 weekly. The midday meal is cooked at the sister home 3 days a week and then transported down and served by the home staff. Whilst the menu does not offer an alternative, records Care Homes for Older People Page 17 of 31 Evidence: demonstrated alternatives are offered and these are listed for each resident. Mealtimes can be varied upon request and residents guests are also welcome to have meals at the home. Medical therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. From discussion with the manager it was confirmed that the requirements made by the environmental health officer have all been actioned. The flooring in the storage and laundry area has been attended to and is now impermeable. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear uncomplicated formal complaints system which is accessible to both residents and visitors to the home. Staff receive training to protect residents from abuse and the home have clear policies and procedures in place for staff to follow. Evidence: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated during the visit to the home. The home has received one complaint since the last inspection and there have been no safeguarding referrals or formal complaints received by the CQC. Relatives and residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the protection of vulnerable adults and staff have received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Wilton Lodge provides a comfortable and clean environment for those living there and visiting. however the safety of those residents who are not independantly mobile are impacted on negatively by the layout of the home. Residents and their families are enabled and encouraged to personalise their room and rooms are homely and reflect the residents personalities and interests Evidence: The home is generally well maintained, furnished and decorated to a good standard. The layout of the home is not suitable for those residents who are not independently mobile due to narrow entrances to the dining area and narrow steps. The home does not have a shaft lift but does have a stair lift to all floors of the home. The restrictions to the physical capabilities of the residents still needs to be clearly reflected in the Service Users Guide and Statement of Purpose to ensure that all placements are suitable and regularly reviewed to protect the residents. The lounge and dining room areas are fairly small but are pleasantly decorated and though well furnished are very overcrowded restricting the size. The majority of the furniture in the home is of a good quality and suitable for the people who live there. This site visit was undertaken on a day with poor weather conditions and so the residents were all in the home and all in the lounge. The lounge on this visit was very Care Homes for Older People Page 20 of 31 Evidence: crowded and residents wandering were at risk from trips over other residents and furniture, the door does have a door guard on but was obstructed by a chair. As discussed with the manager, decisions regarding the homes suitability for its current registration category and numbers of people cared for and of how to keep them safe need to be made. The rooms visited evidenced residents personal possessions, pictures and ornaments. The outside area is accessible to residents in the good weather and furnished with garden tables and chairs. The AQAA stated that further improvements to the patio areas are planned. There are adequate communal bathrooms and a wet room in the home with specialist equipment which enables frail residents and those with a physical disability to enjoy the facilities available. However one bathroom that is used regularly is in need of redecorating and equipment renewel to ensure its welcoming. The manager is aware of this and this under discussion and therefore a requirement has not been made at this time. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms, hoists and wheelchairs if required. One resident was seen to be in an uncomfortable position in their wheelchair and it was discussed that there is a need to apply for a wheelchair assessment to ensure that the wheelchairs in use are appropriate to individual residents. Call bells are provided in all bedrooms but in the lounge and dining area the call bells were not in reach for the residents and this needs to risk assessed as it was not evidenced at this visit that residents at supervised in the lounge area at all times. Though it was acknowledged that the manager who was included in the care rota was assisting in the inspection process, thus affecting the ratio of staff to residents until an additional staff member was called in. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home confirmed they were up to date. The tour of the home confirmed that staff are aware of the fire safety policies, however as mentioned above, one door was found inappropriately wedged open by a chair. Care Homes for Older People Page 21 of 31 Evidence: Polices and procedures for infection control are in place and are updated regularly. The home was clean but as discussed there were strange odours apparent in certain areas on the day of the inspection, this was discussed. Good practice by staff was observed during the day and there were gloves and aprons freely available in the home. The laundry area is in the cellar of the premises and was well organised and has the equipment necessary to provide a good service. The washing machine had broken down and there was a backlog of soiled laundry left on the floor, suitable containers should be used to prevent cross infection. The staff member who is allocated the cooking duties also does the cleaning and laundry and this is a cross infection risk unless the staff member wears alternative protective clothing. This was in place at the last key inspection, but at that visit the staff were not cooking the main meal and therefore the cross infection risks were seen to be minimal at that time. Residents clothes were seen to be well looked after and clean. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment procedures are in place to protect residents and staff training ensures they are aware of their roles and are able to provide the support and care the residents needs. Evidence: The staffing rota was reviewed and demonstrated that the staffing levels are sufficient for meeting the needs of the residents. At present there are ten residents living in the home and two staff are deployed to support and care for residents whilst the third carer organises the meals, cleaning and laundry chores. The staff on duty stated that doing the laundry, meals and cleaning can be too much at times to meet their expectations. The rota evidenced that staffing was alternated and that staff were not stuck on the ancillary work. The staffing levels of the home need to be reviewed regularly against the documented needs of the residents and adjusted as required to ensure residents receive a consistent approach to their care. The staffing rota confirmed that the home has a permanent staff team of eleven carers and a supper assistant. Five staff have completed a National Vocational Qualification (NVQ) level 2 in care with further carers due to commence the NVQ level 2 in care training in the near future. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the Care Homes for Older People Page 23 of 31 Evidence: relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. The induction programme is now in place and has been introduced for all staff. Files seen confirmed this. A sample of individual staff training files were viewed and it was evident that staff had received training in English for overseas staff, Food hygiene, Fire safety, Moving and Handling, POVA, medication, challenging behaviour, Health & Safety and induction. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management approach at Wilton Lodge is open and encourages residents relatives and staff to be actively involved in the lifestyle provided in the home. The health and safety of residents are promoted through an ongoing training and supervision programme for staff and up to date policies and procedures, but the moving and handling techniques observed during the visit place staff and residents at risk. Evidence: The management structure of the home has been formalised and strengthened by the appointment of a manager. Mr Robbins was registered by the CSCI in 2008. He has confirmed that he has commenced a management qualification. Mr Robbins previously worked in the home as the deputy manager and has a good knowledge of the residents and staff. The staff confirmed that they felt supported and that they felt the improvements made to the running of the home benefited the residents lives. Currently the manager works two shifts a week alongside the staff caring for residents and three days in the office attending to the managerial tasks. He continues to be Care Homes for Older People Page 25 of 31 Evidence: supported by the organisational management structure in his role, and to have regular formal supervision with the responsible individual. There are concerns regarding the moving and handling practices used and whilst this is acknowledged by the manager has not been dealt with pro actively. Regulation 26 visits are conducted monthly and a copy is kept in the home available for inspection. The quality assurance systems in the home include questionnaires which are sent out to residents and relatives and other visitors to the home. The introduction of this formal quality assurance and quality monitoring systems has enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. The quality assurance results will continue to be audited and action taken to address any suggestions of improvement will be documented. There are no residents at present who are responsible for their own finances, relatives and solicitors support the majority while the home does not handle the financial affairs of residents. Staff supervision was discussed and staff supervision and appraisals whilst started are behind, the recently appointed deputy manager will be taking over some of the supervisions and appraisals and this will get it back on track. It was discussed that the new staff do need to be regularly supervised and appraised as part of their induction process. Staff spoken with confirmed that they receive supervision and it is suggested that a plan of the years supervision sessions is developed and followed. There are policies and procedures in place to guide staff in care practices and the AQAA received stated they have been updated and reviewed since the last key inspection. In the main the staff are knowledgeable and demonstrated good practice in respect of promoting the safety and well being of the residents, however the layout of the home as previously mentioned does impinge on safe practices and places residents and staff at risk. As previously identified staff were seen transferring a resident in a wheelchair from the dining area to the lounge and due to the narrow doorway and tight turn with steps, this is an unsafe manoeuvre and advice needs to be sought from a specialist agency to protect both staff and residents from potential harm. Staff were vigilant in protecting residents who do wander from harm and doors to the cellar, bathrooms and cupboards were locked. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 that the registered person 10/07/2009 ensures that the Statement of Purpose and Service Users Guide reflects the limitation on the facilities for the less mobile service users. To ensure that the prospective service users, families and placement officers are aware of the restrictions for people who are wheelchair bound. 2 19 13 That the registered person 10/07/2009 ensures that the home is fit for the needs of the service users that are living in the home. This needs to be reflected in the Statement of Purpose and Service Users Guide. That unnecessary risks to service users are identified and as far as possible eliminated. Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the safety of the service users. 3 22 16 That the registered person 10/07/2009 ensures that all specialist equipment is individually assessed to meet the service users individual needs. This pertains to the wheelchairs in use. To ensure the safety of the service users. That the registered person ensures that the staff deployed in the home are following safe procedures in the prevention of cross infection. That all soiled linnen is appropriately stored to prevent the possibility iof cross infection. To promote the service users health and well being. 5 31 12 That the registered person ensures that the care home is conducted so as to make proper provision to for the safety of the service users. That the health, safety and welfare of service users are promoted and protected. 10/07/2009 10/07/2009 4 26 16 Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 38 13 That the registered person ensures that the service users are protected by safe working practices in respect of moving and handling. That the health, safety and welfare of service users are promoted and protected. 10/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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